| NPI | 1477070928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108621) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7001) |
| 122300000X Dentist (Licence: TX 33965) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2024-12-20 |